13.10.1.1. Antibacterial preparations only used topically

ChoiceDrugDosage
1st choiceHydrogen peroxide cream 1% (Crystacide®)

Dose:
For superficial bacterial skin infection, apply 2-3 times daily for up to 3 weeks

or
Silver sulfadiazine 1% cream (Flamazine®)Dose:
Burns: apply daily or more frequently if very extensive
Leg ulcers or pressure sores: apply daily or on alternative days
Fingertip injuries: apply every 2-3 days
For MRSA onlyMupirocin 2% cream/ ointment (Bactroban®)15g

Dose:
Apply up to 3 times a day for up to 10 days
Limit to use for MRSA

Prescribing Notes

  • To avoid the development of resistance, topical mupirocin or fusidic acid should only be used for localised infections and not be used for longer than 7 days. Local microbiology advice should be sought before using in hospital.
  • For acute impetigo, topical antibiotics should be reserved for very localised lesions. Small areas of the skin may be treated by short-term topical application of fusidic acid three to four times a day.
  • If impetigo is extensive or long-standing, an oral antibacterial such as flucloxacillin (or erythromycin in penicillin allergic) should be used.
  • Hydrogen peroxide cream (Crystacide®) may be used as an alternative agent to topical antibiotics.
  • Silver sulfadiazine cream is used for infected burns and ulcers.
  • Topical antibacterials should be avoided in leg ulcers unless used for short courses for defined infections; treatment of bacterial colonization is generally inappropriate.
  • Metronidazole gel is helpful for secondary infections of fungating tumours.

Caution

  • Mupirocin (Bactroban®) ointment should not be used in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment.